The American journal of emergency medicine · 2026
Rapid bolus versus 3-h continuous infusion of 3% hypertonic saline for acute symptomatic hyponatremia.
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Şafak Sedanur, Şirin İlker
Аннотация
BACKGROUND AND OBJECTIVES: Hyponatremia is a common electrolyte disorder in emergency care that requires careful clinical management. Sodium correction, safety, 30-day hyponatremia-related hospital readmission, and mortality were compared between a 20-min rapid intermittent bolus (RIB) and a 3-h slow continuous infusion (SCI) of 3% hypertonic saline in adults with acute symptomatic hyponatremia.
METHODS: This prospective cohort study included 58 adults presenting to the emergency department with acute symptomatic hyponatremia patients were assigned to RIB (20 min; n = 29) or SCI (3 h; n = 29) using a study-specific allocation list. Sodium kinetics through 24 h, safety, and 30-day outcomes were assessed using ANCOVA, repeated-measures ANOVA, multivariable regression, and ROC analysis.
RESULTS: Twenty-four-hour sodium correction was comparable between groups. One overcorrection occurred with SCI; no osmotic demyelination syndrome occurred. Thirty-day hyponatremia-related hospital readmission was 13.8% with RIB and 41.4% with SCI (p = 0.019); In an exploratory adjusted analysis, SCI was associated with higher adjusted odds (aOR) of readmission (aOR:7.04; 95% confidence interval [CI], 1.56-31.80; p = 0.011). Higher baseline Glasgow Coma Scale score was associated with lower 30-day-all-cause mortality (aOR, 0.39; 95% CI, 0.17-0.88; p = 0.025). A baseline sodium cutoff of ≤115.5 mmol/L showed exploratory discrimination for second dose requirement with an area under the curve of 0.754.
CONCLUSION: Both RIB and SCI protocols demonstrated similar short-term sodium correction, with few observed adverse events. The difference in 30-day hyponatremia-related hospital readmission and exploratory associations involving baseline neurological status and serum sodium require confirmation in larger studies.
METHODS: This prospective cohort study included 58 adults presenting to the emergency department with acute symptomatic hyponatremia patients were assigned to RIB (20 min; n = 29) or SCI (3 h; n = 29) using a study-specific allocation list. Sodium kinetics through 24 h, safety, and 30-day outcomes were assessed using ANCOVA, repeated-measures ANOVA, multivariable regression, and ROC analysis.
RESULTS: Twenty-four-hour sodium correction was comparable between groups. One overcorrection occurred with SCI; no osmotic demyelination syndrome occurred. Thirty-day hyponatremia-related hospital readmission was 13.8% with RIB and 41.4% with SCI (p = 0.019); In an exploratory adjusted analysis, SCI was associated with higher adjusted odds (aOR) of readmission (aOR:7.04; 95% confidence interval [CI], 1.56-31.80; p = 0.011). Higher baseline Glasgow Coma Scale score was associated with lower 30-day-all-cause mortality (aOR, 0.39; 95% CI, 0.17-0.88; p = 0.025). A baseline sodium cutoff of ≤115.5 mmol/L showed exploratory discrimination for second dose requirement with an area under the curve of 0.754.
CONCLUSION: Both RIB and SCI protocols demonstrated similar short-term sodium correction, with few observed adverse events. The difference in 30-day hyponatremia-related hospital readmission and exploratory associations involving baseline neurological status and serum sodium require confirmation in larger studies.